Bedside cognitive screening to detect dementia and predict poor outcomes in hospitals

Cognitive impairment in hospitalized older adults without delirium is often undiagnosed. We evaluated the diagnostic accuracy and prognostic value of two brief bedside screening tools-the 10-point Cognitive Screener (10-CS) and Short Portable Mental Status Questionnaire (SPMSQ).

Multicenter prospective cohort of 2003 patients ≥65 years of age without delirium, admitted to 43 hospitals in five countries of the Creating a Hospital Assessment Network in Geriatrics (CHANGE) Study. Screening was completed within 48 h of admission. Dementia was defined as informant-based Clinical Dementia Rating ≥1.

Dementia prevalence was 22%, with 35% undiagnosed. Both tools showed good accuracy for detecting dementia, with the 10-CS slightly more accurate than SPMSQ (area under the curve [AUC] = 0.87 vs 0.85; p = 0.02). After adjustment, cognitive impairment detected by either tool was associated with increased risk of incident delirium, hospital-associated disability in self-care activities, and 90-day mortality, but not prolonged stay.

Brief bedside screening identified dementia and predicted adverse outcomes, supporting its integration into routine hospital care.